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Introduction

Many times, patients come to us with liver function blood test reports, and if there is anything wrong in the report, they panic. They think that their liver is not functioning properly and assume they have liver disorder symptoms.

Today, we will discuss how liver function test is done. So, whenever we need to check if there is any swelling in the liver or if it is functioning properly, we conduct two tests – the liver function test and the fibro scan. The liver function test is a blood test, which we perform under fasting conditions. After this, a 2-3 mL sample is taken, which is then sent to the lab.

When Do We Conduct Liver Function Tests? 

Now, let’s understand when we conduct liver function tests.

1. Screening Test

If we need to diagnose liver disease in the initial stages, we should perform a liver function test. For example, some people are diabetic, obese, or consume alcohol, and these patients are at risk of developing liver disease. Therefore, these patients should undergo liver function tests on time.

2. Existing Liver Problems

The second condition is if the patient already has liver problems, such as hepatitis B, hepatitis C, fatty liver, or liver damage due to alcohol consumption, we perform regular tests for these patients.

3. Drug-Induced Liver Injury

The third condition is drug-induced liver injury. Some patients take medications that increase the risk of liver damage, such as TB medication. TB medications can affect the liver in some patients, so we also monitor these patients through regular liver function tests.

Types of Liver Diseases 

Before understanding liver function tests, we need to understand how many types of liver diseases affect the liver. There are mainly three types of diseases that can occur in the liver.

1. Inflammation (Hepatitis)

Acute Hepatitis:

Acute hepatitis means sudden swelling in the liver. In these patients, there may be fever, loss of appetite, vomiting, and later, jaundice. The main causes of acute hepatitis are hepatitis A and hepatitis E viruses. In some patients, acute hepatitis can also be caused by the hepatitis B virus.

Chronic Hepatitis: 

Chronic inflammation, known as chronic hepatitis, is primarily caused by hepatitis B virus, hepatitis C virus, and alcohol consumption (alcoholic hepatitis). Another condition is non-alcoholic fatty liver disease (NAFLD).

Besides these, there are other conditions that can lead to chronic hepatitis, such as autoimmune hepatitis, where the body produces antibodies that start damaging the liver. If there is excess copper in the liver, it is called Wilson’s disease, and if there is too much iron in the liver, it is known as hemochromatosis. Both of these conditions can cause inflammation in the liver, and if left untreated, they can eventually lead to liver cirrhosis.

2. Biliary Tract Obstruction

The liver’s job is to produce bile, which helps in digesting food. The bile produced in the liver travels through the bile ducts into the small intestine, where it assists in digesting food. If there is an obstruction in the bile duct, it could be due to a stone or a tumour. In such a condition, the patient may develop jaundice, fever, or itching. For effective bile duct obstruction treatment, consult the best gastroenterologist in Delhi.

3. Infiltrative Liver Disease

Infiltrative liver diseases, such as tuberculosis, liver lymphoma, or sarcoidosis, involve infiltration within the liver, which can impact its function.

What is a Liver Function Test? 

A liver function test has four components:

• Liver Enzymes

• Bilirubin

• Liver Proteins

• Prothrombin Time

1. Liver Enzymes

Liver enzymes are of four types:

• SGOT 

• SGPT 

• Serum Alkaline Phosphatase 

• GGT 

SGOT and SGPT 

Let’s begin with SGOT and SGPT. These enzymes increase in conditions of liver inflammation. If there is inflammation in the liver, the levels of SGOT and SGPT will rise. The cutoff values for SGOT and SGPT vary in different labs but are generally between 30 and 50.

If increased SGOT and SGPT levels are recorded (i.e., above 500), it indicates acute inflammation in the liver. The main causes for this are: 

• Hepatitis E virus 

• Hepatitis A virus (rarely) 

• Hepatitis B virus 

• In some cases, drugs like TB medication can also cause acute hepatitis. 

In patients who are admitted to the ICU with very low blood pressure, SGOT and SGPT levels can go beyond 500 or even 1000, indicating severe acute hepatitis. If you are having similar symptoms, consult the best gastroenterologist in Delhi for effective treatment. 

Chronic Inflammation 

If the levels of SGOT and SGPT are elevated but less than 300, it indicates chronic inflammation. The main causes, as we discussed earlier, include: 

• Hepatitis B virus 

• Hepatitis C virus 

• Alcohol consumption 

• Rare conditions like autoimmune hepatitis, Wilson’s disease, and hemochromatosis. 

Serum Alkaline Phosphatase and GGT 

If a person’s blood tests show an increase in serum alkaline phosphatase and gamma-GT (GGT), the main reasons could be either:

• Blockage in the bile duct (due to stones or tumors) 

• Infiltration within the liver

In such cases, we usually recommend ultrasound or MRI scans to check whether there is any obstruction in the bile duct. If no obstruction is found, it may indicate liver infiltration. This could be due to conditions like:

• Primary Biliary Cirrhosis (PBC)

• Primary Sclerosing Cholangitis (PSC)

Both of these conditions can lead to increased levels of serum alkaline phosphatase and gamma-GT in the blood. In such conditions, it is recommended to consult the best gastroenterologist in Delhi for effective treatment.

2. Bilirubin

The second parameter of the liver test is Bilirubin. If someone has a high level of bilirubin in their blood, it means that there is either inflammation in the liver or an obstruction in the bile duct. The main causes of this are viral infections, stones in the bile duct, tumors in the bile duct, or autoimmune hepatitis and Wilson’s disease. If your bilirubin level is high, consult the best gastroenterologist in Delhi for effective treatment.

3. Liver Proteins (Albumin and Globulin)

Another parameter of the liver function test is liver proteins such as albumin and globulin. If someone has chronic hepatitis and it has progressed to cirrhosis, the amount of albumin decreases and the amount of globulin increases in such patients. 

4. Prothrombin Time

Another parameter of the liver function test is Prothrombin Time. If someone’s liver is not functioning properly, their prothrombin time increases. The normal value of prothrombin time is between 10 to 12 seconds. 

Fibroscan and Platelet Count

• Fibroscan 

Another way to assess the liver is through a Fibroscan. Fibroscan is a non-invasive method in which we place a probe on the skin and check how hard the liver is. If the value is greater than 5, it means the liver is becoming hard. The normal value is less than 5. If the value is greater than 5, it indicates the liver is hardening. And if the Fibroscan value is greater than 15, it suggests the possibility of cirrhosis. Consult the best gastroenterologist in Delhi if you are experiencing similar symptoms. 

• Platelet Count 

In addition to all these, another test is the platelet count. If the platelet count is low and the patient has liver problems, it means the liver is becoming hard. When the liver hardens, the size of our spleen increases. Inside the spleen, platelets are destroyed or broken down, leading to a decrease in their count. 

Interpreting Liver Function Test Results 

If we want to know whether someone’s liver is functioning or not, it depends on whether the patient has an acute or chronic condition.

• Acute Conditions:

Parameters like bilirubin and INR (prothrombin time) are good indicators of how badly the liver is affected. If these levels are elevated, it suggests acute liver dysfunction.

• Chronic Hepatitis or Cirrhosis: 

For chronic hepatitis or cirrhosis, we check INR, bilirubin, albumin, platelet count, and retinol levels to assess liver function. These parameters help determine how well the liver is functioning in chronic hepatitis or cirrhosis patients. 

Conclusion:

Normal Liver Function and Fibroscan Results 

So, if someone’s liver function test is completely normal and the Fibroscan value is also normal, it means the liver is working perfectly. Such patients don’t need to worry.